Application Packet 2009-2010
General Instructions Submit the Following: Application for admission. Print or type in English and answer all questions. International applications are online at www.wwcc.wy.edu. Non-refundable application fee of $100 made payable to WWCC (Visa or MasterCard accepted). Official high school and any college transcripts (if transfer equivalency is requested) translated to English. Attested copies are accepted. WWCC requires documentation of English ability: 1. Official SAT score report or TOEFL score of 500 regular / 173 computer / 61 iBT or STEP Eiken Grade 2A or Cambridge ESOL exam or IELTS 5 for regular course enrollment. 2. Official TOEFL score of 400 regular / 97 computer / 32 iBT or STEP Eiken Grade Pre-2 or Cambridge ESOL exam or IELTS 4 for ESL course enrollment. Request official SAT scores (if any) be sent to WWCC. SAT scores are not needed for admission, but are required for academic scholarship consideration and may be considered as documentation of English ability. WWCC's school code is 4957. Financial statement with signed statement from the student's or guarantor’s bank stating applicant has available a minimum of $15,000 to cover first year costs, travel and personal expenses. Health statement with a physician’s signature and verification of inoculation for MMR (Measles, Mumps and Rubella) (submit note from physician or copy of inoculation card). Photocopy of the passport page which lists the student's full name. Additional Requirement: All international students must have medical insurance. Proof of international medical coverage or the College's insurance is required. College insurance is included in the international student deposit.
Applying for Housing: Complete the admission process to WWCC. No one is assigned to housing until they have been accepted for admission. Complete the housing application. Applications are online at www.wwcc.wy.edu Submit $150 housing deposit made payable to WWCC ($25 is non-refundable as a processing fee). When all requirements are met, a room assignment will be made, and the student will be issued a housing contract. The reservation is not complete until the signed contract is received by the Housing Office. Housing assignments for Fall (August) are made after May 1.
Admissions Deadlines: June 15 for Fall (August) semester November 1 for Spring (January) semester
Application for Admission Instructions: Print or type in English. Answer all questions. You may complete and submit the application online at www.wwcc.wy.edu Sign the form. If under 21, a parent or legal guardian must also sign this form. Obtain a check or money order payable to WWCC for $100 US currency (non-refundable application fee). Visa or MasterCard accepted. Mail to: Western Wyoming Community College Admissions 2500 College Drive Rock Springs, WY 82901 USA Program of Study:
English as a Second Language (ESL)
ESL followed by regular college program _ Regular College Program
Country of Birth:_______________________________________________
Legal Name: Last (Family) _ _______________________________________________
Country of Citizenship:_ ________________________________________
Former Name(s)______________________________________________ Official Name on Passport:_______________________________________ Permanent Mailing Address: (where your permanent home is located, cannot be the residence halls)
Name______________________________________________________ Street Address_ _____________________________________________ P.O. Box (if any)______________________________________________ City _________________________________________________
P.O. Box (if any)_ _______________________________________________
Postal Code_ __________________________________________________ Permanent Phone Number: _____________________________________ Cell Phone Number: _ __________________________________________ Email Address: ________________________________________________
Emergency Contact: Name______________________________________________________ Address____________________________________________________ ___________________________________________________________ Phone_ ____________________________________________________
Enrollment Information Planned Semester and Year of Enrollment: Fall (August) 20_____ Spring (January) 20_____ Status: (Check all that apply) New Freshman, no previous college attendance Transfer student, list all colleges previously attended and location__________________________________________________________ _________________________________________________________________________________________________________________
Previous WWCC Student
Dates attended___________________________ Names attended under____________________________________
Non-Refundable Application Fee of $100 + Housing Deposit $150 ($125 refundable) for a total of $250 (Visa or MasterCard accepted). Our Business Office is unable to process credit card payments without complete information Payment: q Visa q MasterCard q Bank Draft q Money Order q Wire Transfer Credit Card Number ___________________________________________ Expiration Date: ___________________ (Month/Year) Full name as shown on the card: __________________________________________________ Complete Cardholder Billing Address: Street Address: ____________________________________________ P.O. Box (if any) ____________________ City: _________________________________ State: ______________________ Country: _______________________________ Postal Code: ______________________ ADM 07/09
Application continued on reverse side.
High School: High School Graduate No High School Graduation
Name of High School:_________________________________________ City, Country:_________________________________________
Graduation Date:____________ Month/Year
Primary Reason for Enrollment: Degree Seeking (taking courses to receive a degree and transfer to a 4 year institution) Degree Seeking (taking courses to receive a degree and go to work in my field) Certificate Seeking (taking courses to receive a certificate and go to work in my field) Taking Courses for Transfer, Not Degree Seeking Upgrade Current Job Skills or Retraining Develop New Job Skills Teacher Recertification Personal Enrichment or Exploration English as Second Language Planned College Major (See list below):_________________________________ Are you planning to live on campus?
Demographic Information This information is gathered for reporting and recordkeeping. The responses to these questions will have nothing to do with the admission decision. Gender:
/ Year_ __________
Marital Status: Married Single Divorced Widowed *If your spouse or children will accompany you, please submit complete names, birth dates and passport photocopies. Ethnic status: Black Hispanic
American Indian, Alaskan Asian
Hawaiian/Pacific Islander White
Do you give WWCC permission to use the following as directory information and release it upon request? Items such as name, address, telephone, email address, birthdate, field of study, enrollment status, degrees, photographs, and awards. Yes No I give WWCC permission to use photos and quotes from me in promotional materials.
I declare under the penalty of perjury that the information furnished is, to the best of my knowledge and belief, true, correct, and complete. Applicant’s Signature_ _______________________________________________________________
Transfer Programs Business Accounting Business Administration Computer Science Economics Marketing Fine Arts Art Ceramics Dance Music Musical Theatre Technical Theatre Theatre Visual Art 2D
Health Science Exercise Science Nursing Pre-Dental Hygiene Pre-Medicine Pre-Pharmacy Pre-Physical Therapy Pre-Radiologic Technology Humanities Communication English Journalism Spanish Western American Studies
Science and Mathematics Biology Chemistry Engineering Environmental Science Geology Mathematics Pre-Forestry Pre-Rangeland Ecology Pre-Veterinary Medicine Pre-Wildlife Biology Social Science Anthropology Archaeology Criminal Justice
certificates and Occupational Programs
Accounting Administrative Assistant Automotive Technology Clerk-Typist Creative Writing Diesel and Heavy Equipment Diesel Technology Digital Design Technology Electrical Apprenticeship
Electrical & Instrumentation Technology Electrical Mine Maintenance Emergency Management English as a Second Language Fitness Leadership Human Services Industrial Maintenance Industrial Safety
International Business/ESL Maintenance Mechanic Medical Office Assistant Mining Maintenance Technology Natural Gas Compression Tech. Office Information Systems Oil and Gas Production Technology Power Plant Maintenance Mechanics Surface Maintenance Mechanics
Education-Elementary/Early Childhood Education-Secondary History International Studies Political Science Pre-Law Psychology Social Science Social Work Sociology General Studies
Technical Theatre Underground Maintenance Mechanics Web Site Development Welding Technology Western American Studies
Application for Housing All students interested in on-campus housing must complete this application. Answer all questions. Please type or print clearly.
For Office Use Only WWCC Student ID #
Name: Last (Family)____________________________First (Given)________________________Middle_____________ Former Name(s)_____________________________________________________________________________ Permanent Mailing Address (where mail can always reach you, cannot be the college residence halls): Street________________________________________________________ City__________________
Phone ( _________ ) ___________________________________
Cell (______) ________________________
Email address_______________________________________________________________________________ Date of Birth:
Month _______ / Day _______ / Year _______
Enrollment Status (check all that apply):
New Freshman — no previous college attendance
Transfer Student — list number of credits transferring to WWCC:_______________________________________
Previous attendance at WWCC — list number of credits completed at WWCC:_ ___________________________ Under what name, if different than above?_________________________________________________________ Have you lived in WWCC on-campus housing before?
Planned semester and year of enrollment: Fall (August) 20_________
Spring (January) 20_________ Summer (June) 20_________
Major (what area of study are you most interested in?):______________________________________________________
Meal Plan Preference: All freshmen who choose to live on campus and all students living in non-apartment units are required to have at least a 10 Meals per week plan. To be considered a Sophomore for meal plan purposes, the student must fulfill one of the two following criteria: The student must have successfully completed two semesters on campus as a full-time student (12 credits or more per semester), OR the student must have successfully completed at least 32 credit hours on campus as a part-time student. Students transferring to WWCC from another college must have completed at least 32 credit hours. A meal contract will be issued with the official housing assignments packet after a student is accepted for admission.
Application continued on reverse side.
Option Requested: Do you require special housing due to a documented disability?
If yes, please describe:_______________________________________________________________________________ _________________________________________________________________________________________________ Will you receive a special ability grant/scholarship for Athletics or Theatre? Yes No If yes, from what team or department?__________________ The following options are available. WWCC will make every effort to place you in the housing unit you prefer. All rooms are non-smoking. Please select your preferences by numbering your 1st and 2nd choice. One Bedroom Apartment: ___ Two Students Two Bedroom Apartment: ___ Four Students Private Bedroom Units (Apartment): ___ Four Students Suite Unit: ___ Two Students - Basement (suite style I) ___ Two Students - Suite Cluster (suite style II) ___ Two Students - Semi-Private Note: All units require a $150 deposit.
Housing assignments are made based on the date the housing deposit is received.
Personal Living Habits (Check all that apply): Are you a:
I like my room:
My favorite kind of music is:_ __________________________________________________________________________ I am interested in living with an international student:
I am interested in living with the following student(s)______________________________________________________ *Applications and deposits should be submitted at the same time. Special interests, hobbies or concerns:___________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________
"I declare under the penalty of perjury that the information furnished is, to the best of my knowledge and belief, true, correct, and complete." Applicant's Signature____________________________________________________
Financial Guarantee* WWCC is required by the U.S. government to assure that all applicants are able to pay costs of attendance. No acceptance letter or Form I-20 can be issued without satisfactory documentation.
Applicant’s Certification Name:_ ________________________________________________________________________________ I have reviewed and understand the annual expenses for Western Wyoming Community College as an international student. I further understand that these are estimates based upon the average student’s costs and that mine will vary depending upon lab fees, extra tuition charges, and which housing and food options I choose. I guarantee that I will have sufficient funds available to meet the educational expenses I incur at WWCC each semester. I further understand that I must have, at all times, a deposit in my student account equal to the cost of the next semester. Although WWCC international students may apply for scholarships, there is no guarantee that I will receive any financial help from the College. I understand that on campus work study jobs are meant to provide additional spending money. I will not rely on a work study job to pay my semester costs. The funds needed for my education will be provided by: (Check one) _____ My family
My own savings
Signature of Applicant______________________________________________________
Guarantor’s Certification Name:_____________________________________________ Relationship to Applicant:_________________________ (1) I understand the expenses for tuition, fees, books, room, board, and health insurance at WWCC. (2) I guarantee that I will provide the applicant with sufficient funds to meet the actual expenses of attendance and that all monetary payments will be made prior to established deadlines. (3) I will provide adequate funds for the applicant’s travel to and from the United States. Signature of Guarantor_ ____________________________________________________
Guarantor Information (please print) Name______________________________________________________ Street Address_ _____________________________________________ P.O. Box (if any)______________________________________________ City _________________________________________________ State ________________________________________________ Country ____________________________________________________ Postal Code_________________________________________________ Phone_ ____________________________________________________
*A signed statement from the applicant's or guarantor’s bank verifying that the student has
available a minimum of $15,000 to cover first year costs, travel and personal expenses must accompany this form. ADM 07/09
Health Statement Emergency Treatment Permission is given to any available physician or member of a hospital medical staff to perform emergency treatment and procedures for _______________________________________________________________________(student's name) as he/she deems necessary and to continue treatment and procedures until such time as the undersigned shall dismiss him/her or engage another physician. This permission includes admission to one of the local hospitals if the attending physician deems necessary.
Parent's or Guardian's Signature (if under 21)
International STUDENT HEALTH FORM
To be completed by the student if 21 years or older - otherwise, to be completed by parent or guardian.
TO BE COMPLETED BY A PHYSICIAN Name:
Last (Family)_ _______________________________________________ First (Given)_________________________________________________ Middle_ ____________________________________________________
Is the student undergoing treatment for any disorder? Yes No If yes, will this treatment be continued while the student is in College? _ Yes No Please indicate any drug to which the student is allergic:
Person to be Notified in Emergency: _____________________________
Does the student have limitation on participation in physical education? Yes No If yes, degree of limitation:
Family Physician: ______________________________________________
Address:____________________________________________________ ___________________________________________________________ Phone:_____________________________________________________ If the student has any serious disorder, such as asthma, ulcers, epilepsy, please indicate:________________________________________________ ___________________________________________________________ If the student has had major surgery (hernia, appendectomy, etc.) within the past six months, please indicate:________________________
Does the student have any abnormalities which require special facilities and/or special considerations? Yes No Has the student any history of mental or emotional disorders? Yes No Date of student's most recent MMR (Measles, Mumps and Rubella) inoculation: Month_______ Day_________ Year___________ (Submit note from physician or copy of inoculation card.)
___________________________________________________________ Is the student currently taking prescribed medicine of which the College should be aware? Yes No If yes, please indicate which medicines: ____________________________
Signature_ ____________________________________________________ Date__________________________________________________________
TO BE COMPLETED BY A PHYSICIAN This student has been examined by me and found to be in good physical health. Note any special health problems:
_____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ Signature of Physician_ __________________________________________________________________ ADM 07/09
Tuition and Other Costs
Approximate Costs for 2009-2010 (2010-2011 costs may be slightly higher): Fall 2009, Spring 2010 Tuition and Fees............................$5,258 Books/Supplies.............................$2,590 Housing (average).........................$2,072 Meal Plan (18 meals/week)...........$1,987 Medical Insurance............................$650 Total . ...........................................$12,557 per semester Deposit: Students must submit a $6,300 deposit for the first .semester costs. The deposit is due upon arrival and check-in on campus. Payment may be made by international money order, traveler's checks, checks drawn on a U.S. bank, or direct wire transfer. Students should budget additional funds for incidentals and personal expenses including meals off campus, laundry and entertainment. WWCC estimates a minimum of $500 for the academic year and $1000 for summer stay (optional). Contact Admissions with questions and for direct wire transfer information.
Western Wyoming Community College is an Affirmative Action/Equal Opportunity institution and as such, does not discriminate on the basis of race, color, national origin, sex, age, religion, disability status, disabled veteran, or veteran of the Vietnam, Gulf, or any other era in admission or access to, or treatment or employment in, its educational programs or activities. Inquiries concerning Title VI, Title IX, Section 504, ADA, and other related laws may be referred to the V.P. for Administrative Services, WWCC Administrative Offices, P.O. Box 428, Rock Springs, Wyoming 82902-0428, (307) 382-1609; or Office for Civil Rights, Denver Office, U.S. Department of Education, Cesar E. Chavez Memorial Building, Suite 310, 1244 Spear Avenue Blvd., Denver, CO 80204-3582, (303) 844-5695, FAX (303) 844-4303 or TDD (303) 844-3417 or the Wyoming Labor Standards Department, 1510 East Pershing Blvd., Cheyenne, Wyoming 82002 (307) 777-7261.
Return application to:
Admissions 2500 College Drive Rock Springs WY 82901 U.S.A. Email: firstname.lastname@example.org Website: www.wwcc.wy.edu Telephone: 307-382-1633 Fax: 307-382-1636